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Caring for Aging Parents

Caring for Your Aging Parents – Top 5 Questions and Answers

Caring for aging parents can be stressful. It’s a new experience, and one that you’re not always prepared for. The good news is that there are plenty of resources out there to help you navigate this new chapter in your life. To help get the process started, we’ve curated the top 5 questions that people have about caring for an aging loved one and have provided answers to those burning questions.

Question #1 – How do I ensure their legal affairs are in order?

No one likes to think about, much less talk, about the end of their lives. Unfortunately, burying your head in the sand can lead to costly and frustrating situations, once your loved one has passed. Of course, coming out and asking if your parents have an estate-plan in place may not be the most tactful approach. Consider these icebreakers to get a conversation started:

  • “Bob and I just met with our estate planning attorney last week to update our will. Do you and dad have an estate plan in place?”
  • “I was so troubled to hear that Uncle Harry passed and left Aunt Hilary with such a financial mess. Do you think you and mom have your affairs, so that doesn’t happen to one of you?”
  • “We just sent Jenny off to college and our attorney recommended a HIPAA release and power of attorney, just in case something happens to her and we need to step in. Do you have a power of attorney?”

Question #2 – How can I gain access to their health information?

It’s not uncommon for parents to withhold healthcare information from their children. This is often because they don’t want to worry their adult children or grandchildren. It may also be because they don’t want to admit that they have a serious healthcare issue. Sometimes, this lack of disclosure can lead to lapses in care.

If you believe you need access to your parents’ medical records, you have a few options.

  • Go to the doctor with your parents. Ask questions.
  • Ask your parents to make you their personal representative for healthcare matters.
  • Ask your parents to request in writing that medical records be sent to you.

If your parent is incapacitated and unable to give consent, the healthcare provider may share personal healthcare information, if they believe that disclosure is in your parent’s best interest.

Question #3 – Is it time to move them to a care home?

When the family home becomes unsafe for one or both of your aging parents, it may be time to consider some sort of alternative arrangement. Nursing homes are not the only alternatives, however. You might consider an incremental approach that includes things like:

  • In-home Care
  • Senior Daycare
  • Assisted Living Communities
  • Additional Dwelling Units

Discuss these options with your parents and other family members to determine what is best for the whole family.

Question #4 – Should they be driving?

Driving is one of the most important activities to one’s independence. Losing the ability to drive is naturally one of aging people’s top fears. Therefore, of course, you want to let them drive as long as it is safe for them to do so. Once reflexes begin to slow, flexibility declines, hearing levels decrease and peripheral vision narrows, it’s time to start assessing the safety of their driving.

How do you assess their abilities? Take a drive with them. See how they do with highways, traffic, driving at night and during inclement weather. It may not be that they need to give up driving all at once. Perhaps night driving becomes a problem at first. If that’s the case, ask them to agree to let you drive at night.

Question #5 – Am I partnering—or parenting my parents?

Often, when adult children are faced with caring for their parents, the go-to position is one of “parent.” It may be one you’re naturally disposed to, because you have children of your own. It could also be that you’re simply mirroring the role your parents played with you. While natural, this may not be the best approach, because your parents may perceive this new scenario as you taking their independence from them.

Instead of dictating terms and telling them how it’s going to be, reframe your roles from parent-child to partnership. Just because they may be lower on energy or losing memory function, doesn’t mean they can’t make decisions. Talk to them like the adults they are, making sure that each of you is maintaining boundaries and autonomy. You may find them more receptive to your help, which will make things much easier in the long run.

Resources:

The Healthy. “8 Questions You Must Ask to Keep Your Aging Parents Safe and Healthy” (Accessed November 29, 2019) https://www.thehealthy.com/healthcare/caregiving/questions-to-ask-your-aging-parents/

HHS.gov. “Under HIPAA, when can a family member of an individual access the individual’s PHI from a health care provider or health plan?” (Accessed November 29, 2019) https://www.hhs.gov/hipaa/for-professionals/faq/2069/under-hipaa-when-can-a-family-member/index.html

Suggested keywords: caring for aging parents, questions for adult children of aging parents

Silver Tsunami

Careful–the Silver Tsunami is Coming!

Approximately one in three homes in the U.S. is owned by someone who is 60 and older. As these millions of boomers decide it’s time to sell their homes and move to another location or to a retirement community, that will have an impact on housing markets, says the article from Market Watch “These housing markets will feel the biggest impact from the ‘Silver Tsunami.’”

In the ten years between 2007-2017, around 730,000 homes that had been owned by seniors went on the market every year. That number is expected to grow enormously over the next few decades. A news analysis from Zillow says that as many as 920,000 homes will go on the market between 2017-2027.  In the ten years after that, the figure may go as high as 1.17 million homes per year.

In total, says Zillow, almost a third of currently owner-occupied homes, around 20 million properties, will go on sale as the direct result of a boomers dying or deciding to move to a smaller home or retirement facility.

The wave won’t hit all at once, and it won’t strike all markets equally.

The biggest impact is expected to be in the Tampa-St. Petersburg-Clearwater metropolitan area in Florida. The Tucson, Arizona area is next in line, with the Miami-Ft. Lauderdale-Port Saint Lucie and Orlando metro areas following.

At the far end of the spectrum, Salt Lake City, Utah, is expected to see the smallest impact from the Silver Tsunami. Less than 20% of homes there are expected to go up for sale, because of being owned by aging boomers.

A few other cities are expected to escape this trend with little impact. They include Austin, Houston, and Dallas, all in Texas.

In other cities, there are micro-neighborhoods that will feel the impact within cities. For instance, in greater Phoenix, all will be well. However, in the towns of El Mirage or Sun City, nearly two-thirds of all homes will be on the market, as they are mainly retirement communities.

Those who are planning to relocate for retirement may want to keep the Silver Tsunami in mind, if their retirement finances depend upon the value of their homes.

Reference: Market Watch (December 3, 2019) “These housing markets will feel the biggest impact from the ‘Silver Tsunami’”

Suggested Key Terms: Silver Tsunami, Retirement Communities, Home Values, Boomers

Stethoscope chestpiece on a calculator

The Medicaid Medically Needy “Spend-Down Program” – What You Need to Know

If you’ve been denied Medicaid benefits because you have too many assets or too high an income, don’t give up. There are available programs that may enable you to qualify for Medicaid benefits, despite this setback. Each state may offer different programs, and the Affordable Care Act (ACA) has added new ways to obtain coverage. This article addresses the “spend down program” offered in every state.

Medicaid Spend-Down Program – The Basics

To qualify for Medicaid benefits, your income and assets may not exceed a certain amount set by law. If these items do exceed the legal limits, you may still qualify after a spend-down period. The medically needy spend-down program helps individuals over the age of 65, and some younger individuals with disabilities. To be eligible for this program, you must not be receiving public financial assistance.

Exempt & Non-Exempt Assets

It is not necessary to sell off everything you own to qualify for the spend-down program. You may keep a certain amount of “exempt assets,” such as the home you live in, your car (used for transportation), household furniture, clothes, jewelry and other personal items. None of these assets affect your eligibility, regardless of their value (unless you have high equity, say $1 million in an asset, in which case you may need to spend that down).

Non-exempt assets, on the other hand, do affect your eligibility for the spend-down program. These assets include bank accounts, stocks, investments, and cash over $2,000 for an individual or $3,000 for a married couple.

Amount of Income You Can Have to Apply

It does not matter how much income you have when you apply. The more income you have, though, the more medical expenses you must incur before your coverage can start. The way you spend down this income is by spending it on medical expenses, until you reach the income requirements for Medicaid. Interestingly, you just need to incur medical costs. You don’t have to actually pay them.

In addition, you can pay down accrued debt to spend down your income. Therefore, paying down credit card bills, car payments, or mortgage debt can count towards your spend down. Another tactic you can use, is to pay excess monthly amounts on old medical bills.

Seeking Professional Assistance

Medicaid programs are different in each state, and the laws change frequently. If done wrong, you could end up incurring penalties instead of obtaining benefits. It may be a good idea to enlist the help of a Medicaid specialist or elder law attorney to walk you through the process in a way that will avoid these types of penalties.

Resources:

National Council on Aging. “Benefits Checkup” (Accessed November 28, 2019) https://www.benefitscheckup.org/fact-sheets/factsheet_medicaid_la_medicaid_spend_down/#/

U.S. News and World Report. “How a Medicaid Spend Down Works.” (Accessed 28, 2019) https://money.usnews.com/money/retirement/baby-boomers/articles/how-a-medicaid-spend-down-works

Suggested Key Terms: Medicaid spend down, medically needy spend down, Medicaid eligibility

Family for Christmas and Holidays

Holiday Gatherings Often Reveal Changes in Aging Family Members

A look in the refrigerator finds expired foods and an elderly relative is asking the same questions repeatedly. The same person who would never let you walk into the house with your shoes on now, is living in a mess. The children agree, Mom or Dad can’t live on their own anymore. It’s time to look into other options.

One of the biggest questions, according to the Cherokee Tribune & Ledger-News’ article is “How to pay for long-term care.”

The first question involves the types of facilities. There are many different options but the distinctions between them are often misunderstood. Assisted living facilities provide lodging, meals, assistance with eating, bathing, toileting, dressing, medication management and transportation. However, a skilled nursing facility adds more comprehensive health care services. There’s also the personal care home, which provides assisted-living type accommodations, but on a smaller scale.

The next question is how to pay for the residential care of an elderly family. This weighs heavily on the family. That elderly person is often the one who did the caregiving for so many years. The reversal of roles can also be emotionally difficult.

There are a few different ways people pay for care for an elderly family member.

Long-term care insurance, or LTC insurance. Few elderly people have the insurance to cover their residential facility stay, but some do. Ask if such a policy exists, or go through the piles of paperwork to see if there is such a policy. It will be worth the search.

Veteran’s benefits. If your loved one or their spouse served during certain times of war, is over 65 or is disabled and received an honorable discharge, he or she may be entitled to certain programs that pay for care through the Department of Veterans Affairs.

Private pay. If your loved one has financial accounts or other assets, they may need to pay the cost of their residential facility from these assets. If they don’t have assets, the family may wish to contribute to their care.

Another route is to apply for Medicaid. An elder law attorney in their state of residence will be able to help the individual and their family navigate the Medicaid application, explore if there are any options to preserving assets like the family home, and help with the necessary legal strategy and documents that need to be prepared.

Meet with an elder law estate planning attorney to learn what the steps are to help your elderly loved one enjoy their quality of life, as they move into this next phase of their life.

Reference: Cherokee Tribune & Ledger-News (November 30, 2019) “How to pay for longterm care.”

Suggested Key Terms: Assisted Living Facility, Skilled Nursing Home, Veterans Benefits, Medicaid, Personal Home Care

Elder Law DIY?

Can You Tackle Elder Law on Your Own?

What usually happens when people do their own estate planning or work on elder law issues, without a lawyer who has years of practice? They may not incur the costs on the front end, but the costs, in financial and emotional terms, often arrive just when the individual or their family is most vulnerable. That message comes through loud and clear in the article “Do-it-yourself elder law estate planning can be risky” from a recent article in the Times Herald-Record.

Let’s clarify the two different areas:

  • Estate planning is about leaving assets to heirs with a minimum of court costs, legal fees and avoiding will contests.
  • Elder law is concerned with protecting assets from the cost of long-term care and empowering people who will be able to make legal, financial and medical decisions on your behalf, if you become incapacitated.

Two of the most important documents in an elder law estate plan are the Powers of Attorney (POA) and health care proxies. If these forms are not prepared correctly, problems will ensue. In some states, like New York, the POA form is long and complicated. Banks and financial institutions will refuse to recognize the form, if they are not completed correctly.

There will be similar issues to a do-it-yourself health care proxy. Here’s just one example of the many things that can go wrong: an agent may not make decisions about withholding certain extreme life support measures, even if they are in possession of a valid health care proxy. There needs to be a living will from the individual that explicitly states their wishes regarding withholding heroic means and/or artificial measures. Without the proper document, the person could remain on life support for months or years, even if this was not their wish.

A do-it-yourself approach leaves much to chance. As a result, the potential for problems is enormous. A far better solution that spares spouses and loved ones, is to work with an experienced estate planning lawyer. Can you put a price on peace of mind?

Reference: Times Herald-Record (Nov. 23, 2019) “Do-it-yourself elder law estate planning can be risky”

Suggested Key Terms: Estate Planning Lawyer, Elder Law, Power of Attorney, Health Care Proxy, Living Will, Statutory Gifts Rider, Nursing Home, Life Support

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